340B Drug Pricing Program Database
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DSH450068AG Memorial Hermann Texas Medical Center (Active)
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Main Details
Name
Memorial Hermann Texas Medical Center
Subdivision Name
Memorial Hermann Rockets Orthopedic Hospital - SMR Physical Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068AG
Medicare Provider Number
450068
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/10/2016
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Memorial Hermann Texas Medical Center
Matt Pruitt, CFO
(713) 704-0112
Primary Contact
Memorial Hermann
Eric John Wucki, Director of Pharmacy-340B
(262) 527-2475
Addresses
Street Address
5420 West Loop South, #1400
Bellaire, TX 77401
Billing Address
Memorial Hermann
929 Gessner Rd, Suite 2690
Houston, TX 77024
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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